Renal Complications Following Extracorporeal Shock-Wave Lithotripsy
Up to 90% of renal and ureteral stones are successfully treated by extracorporeal shock-wave lithotripsy (ESWL) at the present time, either alone or in combination with percutaneous nephrolithotomy. However, despite the wide use of ESWL treatment of kidney stones, few data have been recorded regarding the side effects of the shock waves on the renal parenchyma. Parenchymal, subcapsular, or peri-renal hematomas have been reported only in a few cases, but intra-renal edema and hemorrhage are more frequent. These lesions can be demonstrated by different imaging techniques (131I-hippuran clearance; CT-scan; NMR). The measurement of the N-acetyl-glucosaminidase (NAG) variation levels in urine is a much simpler method to demonstrate early renal damage (1, 2). Recently, second-generation lithotripters became available, differing from the Dornier HM-3 both in structure and wave generation. The second-generation lithotripters were built to achieve an anesthesia-free treatment and, consequently, to cut down the costs of each treatment. In order to obtain the same results, Dornier modified the ellipsoid of HM-3. In treating patients without anesthesia, the lithotripter should generate waves that have a low pressure and a wide skin area for body penetration; this means less pain, less renal damage but, also, less efficacy. Both prolonged treatments and multi-treatments are needed to break up the stones. The aim of the present study was to compare the effects on the kidney parenchyma of the original HM-3 with the modified Dornier HM-3 lithotripter.
KeywordsShock Wave Kidney Stone Renal Stone Renal Parenchyma Ureteral Stone
- 1.E Pisani, GP Zanetti, A Trinchieri, A Mandressi, E Montanari, and S De Franco, Markers of tubular damage after renal surgery: an experimental study, in: “Congres de la Societe International d’Urologie,” A Jardin, ed., Paris (1985), p. 350.Google Scholar